Provider Demographics
NPI:1619073814
Name:VENEBERG, CANDACE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:H
Last Name:VENEBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:H
Other - Last Name:KANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12020 E SHEA BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4179
Mailing Address - Country:US
Mailing Address - Phone:480-767-5600
Mailing Address - Fax:
Practice Address - Street 1:12020 E SHEA BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4179
Practice Address - Country:US
Practice Address - Phone:480-767-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3792122300000X
AR731223P0221X, 1223P0221X
AZ92091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ063499Medicaid
AR184293608Medicaid